Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation
One of the challenges of left bundle branch (LBB) pacing is placing the pacing lead deep enough in the septum to reach the LBB area, yet not too deep to avoid perforation. The purpose of this study was to investigate whether the occurrence of the ectopic beats with qR/rsRʹ morphology in lead V1 (fix...
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| Veröffentlicht in: | Heart rhythm 2021-04, Vol.18 (4), p.562-569 |
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| creator | Jastrzębski, Marek Kiełbasa, Grzegorz Moskal, Paweł Bednarek, Agnieszka Kusiak, Aleksander Sondej, Tomasz Bednarski, Adam Rajzer, Marek Vijayaraman, Pugazhendhi |
| description | One of the challenges of left bundle branch (LBB) pacing is placing the pacing lead deep enough in the septum to reach the LBB area, yet not too deep to avoid perforation.
The purpose of this study was to investigate whether the occurrence of the ectopic beats with qR/rsRʹ morphology in lead V1 (fixation beats) during lead fixation would predict whether the desired intraseptal lead depth had been reached, whereas the lack of fixation beats would indicate a too-shallow position and the need for more lead rotations.
Consecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB area depth was reached vs during the events before intermediate/unsuccessful positions.
A total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, fixation beats were observed in 327 of 339 final lead positions and in 9 of 939 intermediate lead positions (P |
| doi_str_mv | 10.1016/j.hrthm.2020.12.019 |
| format | Article |
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The purpose of this study was to investigate whether the occurrence of the ectopic beats with qR/rsRʹ morphology in lead V1 (fixation beats) during lead fixation would predict whether the desired intraseptal lead depth had been reached, whereas the lack of fixation beats would indicate a too-shallow position and the need for more lead rotations.
Consecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB area depth was reached vs during the events before intermediate/unsuccessful positions.
A total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, fixation beats were observed in 327 of 339 final lead positions and in 9 of 939 intermediate lead positions (P <.001). Sensitivity, specificity, and positive and negative predictive values of the fixation beats as a marker for reaching the LBB area were 96.4%, 97.3%, 97.3%, and 96.5%, respectively. In the prospective, fixation beats–guided implantation phase, fixation beats were observed in all patients and only at the LBB capture depth.
Monitoring fixation beats during deep septal lead deployment can facilitate the procedure and possibly increase the safety of lead implantation.
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The purpose of this study was to investigate whether the occurrence of the ectopic beats with qR/rsRʹ morphology in lead V1 (fixation beats) during lead fixation would predict whether the desired intraseptal lead depth had been reached, whereas the lack of fixation beats would indicate a too-shallow position and the need for more lead rotations.
Consecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB area depth was reached vs during the events before intermediate/unsuccessful positions.
A total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, fixation beats were observed in 327 of 339 final lead positions and in 9 of 939 intermediate lead positions (P <.001). Sensitivity, specificity, and positive and negative predictive values of the fixation beats as a marker for reaching the LBB area were 96.4%, 97.3%, 97.3%, and 96.5%, respectively. In the prospective, fixation beats–guided implantation phase, fixation beats were observed in all patients and only at the LBB capture depth.
Monitoring fixation beats during deep septal lead deployment can facilitate the procedure and possibly increase the safety of lead implantation.
[Display omitted]</description><subject>Aged</subject><subject>Bundle-Branch Block - physiopathology</subject><subject>Bundle-Branch Block - therapy</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>Conduction system pacing</subject><subject>Deep septal lead implantation</subject><subject>Electrocardiography - methods</subject><subject>Female</subject><subject>Fixation ventricular premature beats</subject><subject>Follow-Up Studies</subject><subject>Heart Conduction System - physiopathology</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Left bundle branch pacing</subject><subject>Male</subject><subject>Pacemaker implantation</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Ventricular Septum</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kElv2zAQRokiReO4_QUFCh5zkcNFIq0COQRBswAGcmnPBJdRRVdbScpI_32p2MkxJw6IN_PNPIS-UrKhhIqr_aYNqe03jLD8wzaE1h_QilaVKPhW0rOlLmVRMUnP0UWMe0JYLQj_hM4551W9lWKFujv_rJMfB2xAp_gd3-BhPECHex3-QMDNGHAAbVs__MapBdxBk7CZB9cBNkEPtsU6A9jNYUEcwIQjTEl3GdUO-37q9JBeMj6jj43uInw5vWv06-7Hz9uHYvd0_3h7sytsScpUmFow2XBmzJZBpYWttdMgmOFEyxpK7iQjRBIBFXG24VRYybYUuAFmZcP4Gl0e505h_DtDTKr30UKXF4FxjoqVkpc0Z9GM8iNqwxhjgEZNwefb_ylK1KJZ7dWLZrVoVpSprDl3fTsFzKYH99bz6jUD10cA8pkHD0FF62Gw4HwAm5Qb_bsB_wF77JAg</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Jastrzębski, Marek</creator><creator>Kiełbasa, Grzegorz</creator><creator>Moskal, Paweł</creator><creator>Bednarek, Agnieszka</creator><creator>Kusiak, Aleksander</creator><creator>Sondej, Tomasz</creator><creator>Bednarski, Adam</creator><creator>Rajzer, Marek</creator><creator>Vijayaraman, Pugazhendhi</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3318-6601</orcidid></search><sort><creationdate>202104</creationdate><title>Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation</title><author>Jastrzębski, Marek ; Kiełbasa, Grzegorz ; Moskal, Paweł ; Bednarek, Agnieszka ; Kusiak, Aleksander ; Sondej, Tomasz ; Bednarski, Adam ; Rajzer, Marek ; Vijayaraman, Pugazhendhi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c404t-b9627f32bb82e5a6c9adae62b30a79e43d7200706e50dcf316c7281e3be2c7f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Bundle-Branch Block - physiopathology</topic><topic>Bundle-Branch Block - therapy</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>Conduction system pacing</topic><topic>Deep septal lead implantation</topic><topic>Electrocardiography - methods</topic><topic>Female</topic><topic>Fixation ventricular premature beats</topic><topic>Follow-Up Studies</topic><topic>Heart Conduction System - physiopathology</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Left bundle branch pacing</topic><topic>Male</topic><topic>Pacemaker implantation</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Ventricular Septum</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jastrzębski, Marek</creatorcontrib><creatorcontrib>Kiełbasa, Grzegorz</creatorcontrib><creatorcontrib>Moskal, Paweł</creatorcontrib><creatorcontrib>Bednarek, Agnieszka</creatorcontrib><creatorcontrib>Kusiak, Aleksander</creatorcontrib><creatorcontrib>Sondej, Tomasz</creatorcontrib><creatorcontrib>Bednarski, Adam</creatorcontrib><creatorcontrib>Rajzer, Marek</creatorcontrib><creatorcontrib>Vijayaraman, Pugazhendhi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jastrzębski, Marek</au><au>Kiełbasa, Grzegorz</au><au>Moskal, Paweł</au><au>Bednarek, Agnieszka</au><au>Kusiak, Aleksander</au><au>Sondej, Tomasz</au><au>Bednarski, Adam</au><au>Rajzer, Marek</au><au>Vijayaraman, Pugazhendhi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2021-04</date><risdate>2021</risdate><volume>18</volume><issue>4</issue><spage>562</spage><epage>569</epage><pages>562-569</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>One of the challenges of left bundle branch (LBB) pacing is placing the pacing lead deep enough in the septum to reach the LBB area, yet not too deep to avoid perforation.
The purpose of this study was to investigate whether the occurrence of the ectopic beats with qR/rsRʹ morphology in lead V1 (fixation beats) during lead fixation would predict whether the desired intraseptal lead depth had been reached, whereas the lack of fixation beats would indicate a too-shallow position and the need for more lead rotations.
Consecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB area depth was reached vs during the events before intermediate/unsuccessful positions.
A total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, fixation beats were observed in 327 of 339 final lead positions and in 9 of 939 intermediate lead positions (P <.001). Sensitivity, specificity, and positive and negative predictive values of the fixation beats as a marker for reaching the LBB area were 96.4%, 97.3%, 97.3%, and 96.5%, respectively. In the prospective, fixation beats–guided implantation phase, fixation beats were observed in all patients and only at the LBB capture depth.
Monitoring fixation beats during deep septal lead deployment can facilitate the procedure and possibly increase the safety of lead implantation.
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| subjects | Aged Bundle-Branch Block - physiopathology Bundle-Branch Block - therapy Cardiac Pacing, Artificial - methods Conduction system pacing Deep septal lead implantation Electrocardiography - methods Female Fixation ventricular premature beats Follow-Up Studies Heart Conduction System - physiopathology Heart Rate - physiology Humans Left bundle branch pacing Male Pacemaker implantation Prospective Studies Retrospective Studies Ventricular Septum |
| title | Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation |
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